<br />
<div class="form_container" style="width: 680px;">
	    <div>
	        <span id="status_message" style="font-style: italic; color: red;"></span>
	    </div>
	    <input id='note_id' type='hidden' value='{$note->prescription_note_id}'/>
	    <table cellspacing='0' cellpadding='0'>
	        <tr>
	            <td colspan='4' class='field' style='text-transform: uppercase'>{translate}Add - edit presription note{/translate}</td>
	        </tr>
	        <tr>
	        	<td class='label'>{translate}Presription note{/translate}</td>
	        	<td colspan='3' class="field">
	        		<input id='note' type='text' size="100" value="{$note->getLocalizedText('note')}">
	        	</td>
	        </tr>
	        
	    </table>
	    
	</div>
	
	<div align="right" style="padding-top: 10px; width: 700px;">
	    <div id="btn_save">
	        <a id="button_save" class="button_link" href='javascript:savePrescriptionNote()'>
	            {translate}Submit{/translate}
	        </a>
	    </div>
	    <div id="barLoading" style="display:none;">
	        <img src="{$base_uri}images/ajax-loader.gif"/>
	    </div>
	</div>